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75 WASHINGTON ST - BUILDING INSPECTION (2)
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'' n ..:. � :_ r�, � , ,`i ',; The Commonwealth of Massachusetts � �� ,� Department of Public Safety F„ d.y j. \I.i..,�ihu.i9b titatr (iuildin�Ciide 1:80 CJ1R)��'enlh Edilwn � � ' City of Salem Buildin Permit A lication for an Buildin other than a 1- or 2•Famil Dwellin I/ �ThistirctiunFurl�(ficialUvel�nly) . , 1 /�U Budding Prrmrt .Vumbrr: D.nr Apf�lird: BuddinF Insprctur: � � �SECTION l: LOCATfON IPlease indicate Block N and Lot N for locatione far which a street address is not availabl WQS�� O S - ��Nn Nl � Q �!'eCn�7.nCl C4�'C' \��. ,ind titrert C ih' /T�r�cn Zip Code N,ime�f Building (if apf�licablr) 5ECTION 2: PROPOSED-WORK II New Cunsuuetiun check hrre O�rr check,ill th.it,�pply in the two ruws below Existing Building❑ 2epair❑ Alterafiun ❑ Additiun ❑ Demulifiun ❑ (Please fili out and ,ubmit AF�pendix t) ChnnKe�fUsr ❑ ChanKe�fOccupancy O (Jther Specify�'sxhe�C.�b.� K.i1C�+i`� Ex�.aVSi'• Are building plons and/ur cunstructiun ducuments being�upplied as part of this prrmit application7 Yes i�lo ❑/ I.an independent Slructural Engineering Peer Review required? Yes ❑ No H Brief De�cripli�in uf Prup��s�d W�rk:�=�n>�'u.\� o. Co�hprC�`e..� K��CI,�`� Fx1..ays'1 $'v.r�e�. W/MAK.�-U�(1 q;C' llsi-� -l-1,e {�uci' -F�i was Kviousl.� Sv�e1�.I�e T�+rou�t-� 13v�_ '� SECI'ION 3:COMPLETE THIS SEC'fION IF EXISTING BUILDINC UNDERGOWG 2ENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Evaluation is enc�osed(See 780 CMR 3402.0) ❑ � Existing Use Group(s): Proposed Use Group(s): P Existing Haz.vd Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: SECTION 4: BUILDING HEIGHT AND AREA Existing Propused No. uf Fluors/Srories(include basemrnt Ievels)&Area Per Floor(sq. ft.) Total Area(sq.ft.)and Tutal Height(ft) SECTION 5:USE GROUP(Check as ap licable) A: Assembly A-! ❑ A-2r ❑ A-2nc❑ A3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑ ` F: Facto F-1 ❑ F2 O H: Hi h Nazard H-1 ❑ �H=2-❑ H3 � H-4 � H-5❑ L Institutional I-t ❑ I-2 ❑ I-3❑ I-�1❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-d❑ S: Storoge S-I � S-2 ❑ U: Utility❑� Special Use O and please describe beluw: � � Sperial U�e: SECTION 6:CONSTRUCTION IYPE(Check as a plicablel IA ❑ ID ❑ IIA ❑ , 118 ❑ IIIAO 1118 ❑ IV ❑ VA ❑ L'8 ❑ SFCTION 7:SITE INFORMATION (refer to 780 CA1R 1llA for details on each iteml Water Supply: I Flood Zone fnfomiation: Sewage DisposaL• �rench Permit: Debris Removal: � Pubhi❑ C hcck il uuL iJr PLn�.i /_��nc ❑ Indierie muniaF+al ❑ :\ trench will nut be Licem�d Di.p�r�.�l �ite ❑ � reywrud �ur trench ��r,��ecil'c�. I Pnr.itc❑ ��r indrnh�c 7_unc:_ ur nn .�lr.��.trm ❑ . . ��vrmit i.enelo.rJ ❑ � Raiiroad n5ht-uf-way: Hazards to Air Vavigation: �L� I I�.i�,n� c�,.nnnn.i„n R,��i��" I'n•�...: � i ' \nl .\f�F�h:ablc❑ I.ti(ruilurc ��i�h�n ,urF�urt e�,F�n�.�di arr.�' I. U;cir rc�icu� c�nnF�IcIcJ' 1 i � '�_ ,�r ( ��n.rnt l�� 14ui�.l .'nil�nr�l ❑ � lr. ❑ ur.A�u❑ l�e.� \u ❑ � i SEC"flOti 8: CONTEVTOF�ERTIFIG\fE OF OCCUPA�VCY,� { �. I..fi�n�n �,� C'��dr ___ ��c l;r��up�.[ f�Fc.�� l,m.tru.Uun: t]ccuF,int I��a.i F�i�r I�Irn�r .____ � ilL�r, ih�•buil.linq:��nt.un.intiF.nnl.lor}�.�em'� _ ���riial?IiF�ulalinrn� --� +� ��r/l �n�'��' �� � � �� o`llo ► , �4A SECTION 9: PROPERTY OWNER AUTHORIZATION � � � �V.�ma and ,1ddn.+�N Prnprrtv Owner �1 l�c�sM�.�C,H S�'• �ol E'aicie LLC ? IQv,io�1 S'�. �P�(c� 1 �R, a) (J Vamr IPrinU :Vu..ind titrcel _� l�i�rwn LiF, PruF.crt��l)���ni•r(��mt,ic� Inlurmatiun: (r.�;ll�n.� GolcQl�e� 9�18-92Z_ pgLAp =_ , Titli Trlrph�ine Vu. ibu.ine..l TrlrF+honr No. (crll) r-mail.tildrea.: I(.�pF�lii.�ble, thr prnpertv u���ner hrrcbv authunzes �ac-Ic S�/DMh�I zs Sxth S�i�cct Cl��ls��. /J1A OZISo �amr titrcel Addrc., Cih�/Tuwn tit.itr ZiF, lu,xt�m thr �ni,rrh�.nvner's brhalf, m all matters rcl,iticr io wurk eirthonzed bv this buildin � �rrmit a > >lic.�ti�in. SECTION 10:CONSTRUCTION CONTROL IPlease fill out Appendix 21 111 l•uildin•i�Ics.lh�n li.lNlU.u.fG uf dndi�s�d<+acc and/or mrt unilcr Con.truction C�inlro�thcn chr<k hrrr O.�nd ski�5edion 10.1) 10.1 Re isfered Professional Res onsible for Construcfion Co�trol Name(Rrgi;trant) Telephune Nu. e-mail address Registrntion Number titrcrt Address City/Tuwn titite Zip Dixipline Expir�tion Date ��I lOS Generai Contractor � S6/DMAn1 �KoS.�.r-tC � Company Name: � �,� Sc,nn�n�y �S ?Zt�� Namr uf Prnun Re+�nmsible Fur C�nstructiun License No. and Type if Applicable 2.� Syc-tln s�4�ce� ('(�.c`Sc� �I� U21SC� Street Address City/Town � State Zip (�-�- 811C� __ .IhCK� SE'InMAa(BROS.C(�M Tele hone No.(business) Tele hone No.(cell) � e-mail address . SECTION 11:WORKE25'COyII'ENSATION INSURANCE AFF[DAVIT(M.G.L.c.152. 25C(6)) A Workers'Cumpensation Insuronce Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this npplication. Failure to provide this affidavit will result in the denial of the i uance of the building permit. fs a si ned Affidavit submitted with this a Ifcationl Yea�No ❑ � SECTION 12:CONSTRUCTiON COSTS AND PERMIT FEE Item Es[imated Costs:(Labor and Materials) Total Construction Cost(from Item 6) =S 1. Building $ (S(Q9 Building Permit Fee=To[al Cunstruction Cost x_(Insert here 2. Electrical $ appropriate municipal Factor)_$ � 3. Plumbing $ Note: Minimum fee=$ (contac[munici �lit ) 4. blechanical (HVAQ $ � P` Y 5. Mechanical (Other) $ Enduse check � ible to 0 P•Y� 6. Tntal Cost S � (contact mimicipality)and write check number here SECiION 13:SIGNATURE OF BUICDING PERMIT APPL[CANT !iv untenn� my name belnw, I herebv.�ttest under the Fiains and F�en�iltir.ul perjury that.JI uf the in(urm.ttium m�tained in thi. ,if>pGc.�hun is true��nd accurate t Ihe be- uf mv knowledtie ind imdenlandinh. i � � � I JQC� �El�M �as'�Nc�toN Sc�'^viithk �v�) .�� �l�b Z 9 0 v — II'Ic.i.i� F,nnt and.i�;n namc (illr frlcphunu \'�i. I?alc I 7.T �xi�, 5�rce'f� Cf�e�scc� ��R a2fS� I }t:rct .\�i�irc.. CrtafLncn � e GF• i � \luniiipai Inspertor to fill ou[ this section upon application approval: i � V'ame I).i le � �r . ; ����s, �� �17v , .. � � The Commonwealth ofMassachusetts � Department of Industrial Accidents �� �� �±� Office of Investigations �� '�"' " �' 600 Washington Street � .� �� Boston, MA 02111 `��� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeiblv N3me (Business/Organization/Individual): ��'(�/��{.� �/ZpS, TNC Address: ZS s i�c-Fh �1`. City/State/Zip:�(n c(Se c� /�� 0 Z ISc� Phone #: G I7 -gg�I - $�I 0 A,r�e,/you an employer?Check the appropriate box: Type of project(required): 1.VY I am a employer with� 4. ❑ I am a general contractor and I employees(full and/or part-time). . have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, � Demolition working for me in any capacity. employees and have workers' 9 � guilding addition � [No warkers' comp. insurance comp. insurance3 I required.] 5. � We are a corporation and i[s 10.❑ Electrical repairs or additions ( 3.0 I am a homeowner doing all work officers have exercised their ��,� plumbing repairs or additions mysel£ [No workers' comp. right of exemption per MGL �Z � Roof repairs insurance required.]t c. 152, §1(4),and we have no �y employees. [No workers' �3.0 Other K'�9r.�^e`� Eh�wS'F comp. insurance required.] *Any applican[tha[checks box N I must also fill ou[the scclion below showing[heir workers'compensa[ion policy infor�nation. t Flomeowners who submi[[his affidavit indicating they are doing all work and thcn hirc ou[sidc contractors must submi[a new affidavi[indicatin�such. IContractors that check tl�is box must a[[ached a�i additionel shee[showing thc name of the sub-�ntractors and state whether or no[thosc en[ities have employees. If[he sub-con[rac[ors have employecs,[hcy must provide their workers'comp,policy number. I am an employer Ntat is providiirg workers'compensa[ion insumnce fnr my employees. Be[ow is the po[icy and job site information. " / InsuranceCompanyName: /-�qr�e�nsv �l�� Z���..�ce � � v Policy#or Self-ins. Lic.#: (.J C �MS7G� Expiration Date: 3 31 20�0 JobSiteAddress: "67 Wo.s�i�{or� �oee"� � City/State/Zip: �-�a.y �Vi� , G�9�0 Attach a copy of the workers' compensation policy declaration page(showing'the policy nomber and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDGR and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. /do kereby cerC u der 1G pains anJpenalties of perjury tlent tlee information provided ahnve is true nnd correct. Si namre: c Date: Z 9' 2C�[O Phone#: �f7 -�$Y�PJIlO Officinl use only. Do not write in d�is nrea,[n be completed by city ar town officinl. City or Town: PermitlLicense# Issuing Authority(circle one): 1. Board of Health 2. Boilding Department 3. City/Town Clerk 4. Electrical Inspector 5. Plombing Inspector 6. Other Contact Person: Phone#: ' �'� CERTIFICATE OF LIABILITY INSURANCE oP�o � °"'�'"""°°"""'" PRODU� � � - SEIDM-1 ii/oe os . . - � , THIS CL'RTIFICATE IS ISSUED q5 A MATTER OF-INFORMATION � � � � �ONLYAND CONFERS NO RtGNTS UPON THE CERTIFICATB. 3anviti� IAeuraaa0� � � WOLDER.TH13 CERTIFICATE�DOE3 NOT AMEND,EkYEND.OR . 699 Sroadway ; � � � , ALTER 1HE COVERAGE AFFORDED BY THE POLICIES BELOW. �- Everet� D� 02149 PhonezSl7-389-2020 Fax:617-369-2418 INSURERSqFFORDiNGCOVERA�E Nq�ck ' WSUNED � � . � - INSUpERA ([gz10 9V31,�.0 I313 Co.� 35696 - � - ' � INSURER Bt - � � � � - seidman Hrothera wsuflr'Rc: � � . - � �'25 $j.XtY1 $t BBt � - -� W6URERD: � � . chelaea 29� 0�2250 . . , � . . � WSURER E � � . � COVERAGES � - � � � � . � - � , iNEPOWCIE60FINSURANCEU5TED9ELOWMqyENEEN�$$UEAYO.TMEINSUREOWiME�q90VEFOiYTXEPOIJCVPFR10DINDICATED.NOIW�TH9TANDIN('i ' ' . ANY.REQUIREMENT,LERMORCONDRIONOFANYCONTRACTOROTNEROpCUM9VTYVITNRESPECT'TOWHICNTHIBCERT,IFICATEMAY9E1$$UEDOft ' � � . � MaYPEf2TAW,THEweURANCEnFFOR0ED9YTitEPOLIC10sDE3CRIBEDHEREINISfiUS.lEC770ALLTHE7ERMS,ERCLU31oNSANOCONort10N50F6pCH � � . 70LICIE6..pGGNEGATE LIMIT$&HDWN M4Y H4VE BEEN REDUCED BY PAID CUVMS. � � � . � � � . . �CECI'IO 'VEXGIHAtfa - . . . � LTR 71'PEOFIN911RqNC6 Po4CYNU6IBEP. OATE EeWOGlYYW 7E MtalD��tp LIt91TS � 6ENERAL4ABIIJTY . ' . ' . � . . - � FAOHOCCURRENCE 3�.000000 ' B R ComrnEaCWlOeN�w.LlaBartr �3pP68891D 09/15/09 09/15/10 p�enis���ar,no;, a 300000 � . cwrns mnoe Xn OCCUR MED EXV(My mq porGql) a 5000 . . � ' .. PNtSOW1L&PAVINJURY � S 7:000000 '� � - ceNEan�neGREca� 92000000 GEN'LnGGPE6ATEUMITnPPLIESPEx: . PRODUC75•COMP/OPAc,G 82000000 �� �POUCY ��T LOC . . . . . Al1TOAlOWLE WOYIry � . � � . COMBINE081NGLELIMR y 1000000 A nrivnuro SA66198D 10/OB/09 10/08/SO «'�'d°m) ALL ONMBD MUiD6 ' . . ' � � BODILY INJUftY a � $ SCHEPULEDAIl�OS . � . ' ' (PbtpWall) � X FURE0AUT06 ' � � - � � BOOILYINIURY ' s . X NON-0WNEDI1UY08' .. . . . � � . . (ParuaidaN) � raoPeRnou.ucs . s i000000 � � (Pw eeeideN) GAPAGELIaBu.17y� , � AVTOONLY-EAACCIOENT Y � � M1YAUf0 ' . � ' . . . OrHERiww - EnACC ; � ' AUTOONLY: � qGG e � ' EXCESS/UM9HEWLIABIIAT'! � . ' . EACHOCCURRENCE� . .a . OCWR � �CWMBMADE � ' � ' AGGR6WTE C g DEDUCneLE � . . � � i RE7EM'IDN S - � . . . . � � . wORKE cOmPENSAribN . . . . . . . � � . . � $ . . ANOENPLOYFJi6'IUBIU7Y ' Y�N . . � ' TORYLIMfTS ER� � 8� �+NVPROPWEYOP1PqRTNEWFJiEdUrn�—i WC 4M8765 � � - 03/31/09 � 03/31/10 e.�,Encnnccmerrr s100000 1�eFendaw�iyEniN9�,E%CLUDEo9 �� . . . . . . � . . , . . . . . y9 - E.1.018EASE•�qFjtlpLpYE S].00OOO SPEC PROVI810NSbdow - � ' ' E�L,OIBEASE•POUCYLIMR SSOOO�QO OTXER . � ' - � - . . DE4CPoPTIpN OF OPEPA710N$1 lACATIONS/VEl�1Cl.E61 EXCLI1810NS AD�EU BY ENOOR$BM@kY/9PECIAL�PRpV1610N9 . . . � � CERTIPICATEHOLDBR� � � � � - � :CANCELLA710N � � � � � � . .. . . . .. . . . .. . ' . � '� � , ' � �, � � . � �SHOOLOANYOPMBA80VEOESCRI9EDDOLICIRBECANCELLEDBL�FORETMEIXPIRA110N� ' � � ' . � DA7ETHEflEOF,TNEISSUINGINBlIREItWIILp,HOEAVORTOMAIL �}'O DAYSWRfTTEN . �, � - � � NOTICETOiHECERTFIGATOHOLDERNAMEOTOTH2lEF(�9UTFAIWFETOD060-SNALL , � � . . � 'INPOSBN0�06LIOAT10NpR4WBILI7YOFFNYqNDUPON7HE1N9URER,R$AGENTSOR" . � � R2PRFSENTATNE&�- �• � � . . . .. . AVINOHI2EDREPREBE M .. . ' Saaviti Tna ce ezx g �� ACORO 25(2009I01) � � . , _ �- �1888-2009 ACORD CORpORAT Aq�Ights reserved. . �f � � � . . � . . � The ACORD name aod logo are registered marks„oE ACpRb . ,� ' � . . . � . .� � . . . � .. , . � . . � - � I I0 3917d , S 8tUZ68ELL9 LE;GT 600Z/90/TS � , 25 Sixth St. _ � � BROS. INC. USAsea, MA 02150 Sales Order Number: S06871 Sales Order Date: Jan 11, 2010 � � 's�`�`�� �, `� rrDr� Shi B Jan11, 2010 n:=;;��.� i �,�. , ,ei„_<.,.,,,,,,,�n�.,�n,„i�����,,�_�„<�,,, Voice: 617-884-8110 P Y� � c�.,«���s,,,;,,r,,,;�,a;r�,��.����;:i„�� � Fax: 617-884-4284 Page: 1 c.:d i .��� �!" �� t.a� .: � fTnr P .I: r . ... To.,��Gt a_ r �" t �"t�� . �aw�� Ship To q� �af M.: „� ,�, ` `a � i u L ad.u..�orvv.a .:Tx..�S!. . . ii ..�..�. s ^^! ..�HiUI.....L. m .... . { Green Land Cafe Green Land Cafe 87 Washington Street 89 Washington Street Salem, MA 01970 Salem, MA 01970 Voice 617-413-9148 Fax ,. ., ... __ . � ���C�Customer ID 1 !� � ��,oU� w�;�PO Number' '4 '°ifi„�A � ,� N� .�Sales Rep Name,_":�,�'Ii�=`{. ; .___� �.. Green Land Cafe � Jack Seidman � ` _ ,�,Customer Contact r h ` : ,n ' �� � Shipping Method;�. " , _ .....,, �'�:: , :EE�Fd��r���°�,;�`,s=Payment Terms'�'�� s � ,Ea _ ,,., ___.... a .. r Paul Bolden Our Truck I C.O.D. I "'�a:%Quantrt i'.'� 3�—r� �_.,�nnare� �..�"�� �l�t�DQSCtIptlOfl'�'� �i�r :�i s e �� nit Price : � Y ,a�ltemm,� : <<:. , �. a U , .. euP�.... ;_ AfIIOUfltutn�sli_� ..,,._._. .. ., s .. 14.00 se makeuphood 14' Stainless Steel Rear Discharge Make-up air Hood 285.00 3,990.00 with Baffle Filters and removable Grease cup. Priced by the foot. 2.00 p 24h Hood light fixture complete with Globe. Mounting hole 45.00 90.00 cut into the hood. 14.00 se ssrdpnl Stainless Steel wall panels mounted on wall under 45.00 630.00 rear discharge, by the foot. 1.00 se exsys Exhaust System with 24", 1hp, 2 speed, 120v. 2,795.00 2,795.00 upblast Fan, duct mounted hinged fan curb, Grease trap, and 19"x 19"welded Duct.4800 CFM @ 2075 FPM. The dud will run inbound from the property line above the roof from the top of the pre-installed duct. It will also connect the bottom to hood. 1.00 se musys Make-up air System with 15" 1hp, 2 speed, 120v, 3,560.00 3,560.00 in-line Blower Fan,with a Filtered inlet in existing window, and Ductwork. 4400 CFM = 92% retumed to ' roo m. 1.00 Job-Fire UL-300 Fire suppression system to coverthe hood 3,145.00 3,145.00 duct and listed appliances under the hood. (VaNe to be installed by customers plumber NIC) Job-engdnv Stamp the engineered plan that we got done before 750.00 Subtotal I Continued Sales Tax I Continued� Freight Continued I TOTALORDERAMOUNT v�� , �6fi` ���'' - ��� ` '^` 'Contmued'. . . . .= s.� . _�.. ��. _.. xh re rv� .. ,.�:� Finance Charqe is comuuted at 2% monthly (24% APR) on all balances over 30 days old. 25 Sixth St. � � BROS. INC. Chelsea, MA 02150 Sales Order Number: S06871 USA Sales Order Date: Jan 11, 2010 i � �s � r� �� . �q . �.���%«.� r .,,,_,, �,mJ,��„�� �,n��nn,.,S:rno,,»5„�r„�� Voice: 617-884-8110 Ship By: Jan 11, 2010 . . c�,,,�„„s„e„r..,,�a,�,�r„v.a��,:.��� P age: 2 Fax: 617-884-4284 � � To:. ��- � . �t . , ,� ... _ Ship To ` g 4....:,, - � ., ',n .___ „tio_.. � � Green Land Cafe Green Land Cafe �� �� 87 Washington Street 89 Washington Street Salem, MA 01970 , Salem, MA 01970 Voice 617-413-9148 Fax �..,: �3�'Customer ID' . �,° �� ' ° '"�`-'��'i�? " �+�!3'PO Number y� .�r, � Sales Rep Name�^„�, _ , �,;,I . _..._,..�.... _.. A�Lv�ii �d} .:e•ei. _ .. . _......_ 3_�_.�.�.a¢'�I ,. ,I Green Land Cafe Jack Seidman ,�g,�': �Cu§tomer Contact � E �', a,�„j;���,=n ' '�Shipping Method,`,G� " , �'��'�I �.�.u�,_ . _ ..�.. �.. �� u!� . .=_"rt � r, ' `PaymentTerms�E �_ _ ____ . .._. .: I Paul Bolden Our Truck C O.D. � «,�e^Quantity�.�..�, u�. a,. :�ltem��z ..,-:. ,'�JD�t;h�r, .;.,.Descripti9n° ,. .'°�,..�ai,� '' .r.r�'UnitPrice '� :.�. �Amount'� y.��; � ,:.:. --- ,.,. . �. . . �,�— of the exhaust system for the Building Dept. Qf �I required by the tawn) Job-Prmt cnslt Consulting with Inspectional Services in your town. 550.00 Includes permit fee. Price includes delivery and setup of listed equipment. j Unless specified, NO plumbing, electrical, carpentry, or subcontracted work is included in price. � I I Fire system price includes the eledric as well as the mechanical gas valve. A deposit of 1/3 is required to place the order, 1/3 when installation begins, and a final payment on completion of our work. Original Quote 10/06/OS 1 I S ubtota I 14,210.00 Sales Tax 888-13 Freight 0.00 ,: ,�„< . _ , TOTAL ORDER AMOUNT � � � � � E�. � �� � ' 15 098.13� - -- ,. � txa. . . . ... .ri,I�t,w C < <._-•• A,,..>j Finance Charqe is computed at 2°/a monthlv (24% APR) on all balances over 30 days old. 02/10/2010 14:09 9789220833 GOLDBERG PROPERTIES PAGE 02 � COL�DBERC , , � Ecbruary 10, 2010 Re: Gteenland Cai'c of 85-87 Wa�hia�,n.pn Street. Salem, Massachusetts I, Steven d, Goldberg as managcr/owncr of 81 Washington Street R.eal Fstate I.T.C. herehy give permissiun fo Tack Scidrnan of Scidman Lirothcrs Ii1c. located at 25 Sixtl� Street. C:heisea. MA to apply tor a permit to install a co�tzntercial l<itchen exhaust system in our huilding nn bchalf of the �w�nexs of tlie Czree��land Cafe and Sl Washington Street Real P.state T,T.C. Sincerely yours: ` i ,. , I , Stcven ,l. Goldbcrr Sei�ior Yartncr Goldbcr�Properties Managemenl 1na 7 Rantoul Sneet Suitc ]00 B � lieverly, MA.. OI915 tilc:Rl N+a,ahinttnn SIrUt�rw:nl;ind Cald SciJmnn[lruz,6re - Harbor Piace • 7 Rantoul Street. Suite 100B . Beverly, MA 01915 tel: 978-922-0800•fax: 978-922-0833 • www.goldbergpcopertiesre.com, . ED�IPMENT SCHEO�LE�, � . ,' nu-t s. AIR a�ENunN EXHA�ST HO�� - STAINLESS STEEL REAR OISCHARGE EXHA�ST HO��, � ' . 12'-8", X 48° X 24" HIGH, WITH F�LL LENGTH FILTER RAIX, ALL WELOEO GREASE SHELL [� � REM�VA9LE GREASE NP, ANO �L LISTEO 6AFFLE FILTERS ANO LIGHT FIXT�RES. � � .� EF -I - 24" �PBLAST EXHA�ST FAN WITH IHP, 120V, 2 SPEEO MOTOR, AN� REM�VpBLE GREASE TRAP. � � � i� � . 4800 CFM @ 2075 FPM IN A t9" X 19" �R ED�IVALENT WEL�EO I6 6A GALVANIZE� O�CT. � � � � � aaSE THE O�CT WILL RiJN �P THREE ST�RIES TD THE RO�F THR��GH A FIREPROOF SHAFT. � � � ! 4e� MIJ-I - MAKE-�P AIR SYSTEM WITH IS", IHP, 120 V. 2 SPEEO 9L�WER FAN IN A � ` WALL MO�NTEO FILTEREO HD�SING, 44W CFM = 92'l RET�RNEO TO RO�M � � io' MiH FIRE S�PPRESSION - A �L-300 FIRE S�PPRESSION SYSTEM WILL BE INSTALLE� TO C�VER THE HOOOS, �' � q I ��CTS, ANO APPLIANCES �N�ER THE H000. � � � , � •_ .�l � iz e � - . NOTE: I1P�N ACTIVATION �F THE FIRE St1PPRESSION SYSTEM, THE EXHAl1ST FANS SHALL REMAIN �N, Q � � ANO THE S1IPPLY SYSTEM, GAS FEEO ANO ELEQRICAL FEE� TO ITEMS IJNOER THE H000 � � ' (INRIJOING LIGHTS) SHALL SHtIT OOWN. � � � � 10' MIN . � � � SYSTEM IS BtJTLT TO MEET NFPA 9fi ANO ALL LOCAL Bl1TL�ING COOES. � i �� i EF-� � _ y , � ROOF TOP PLAN O W O � � � � � � 10' MIN W 10' MIN� � \II �/ " � � EF-1 EF-I � � -� } CLEAN ' w � m - w m MASONARY WALL 0�T CLEAN � Q � z � � W � (BRICKI ��T U OL Q U- OOCT MASONARY � (/7 O O , I2" % 31" BOAR� I I I� / I I � h ... �1� � �4,,' �� � fbG bCR E W. �'j:. INTERIOR SHAFT � s �{J ' aJ„ ~ SIZE IB' 0� �p . V � � 19" X t9" OIJCT s METAL STLI�S / �INTERIOF SNAFT � SIZE 44" � �i i� 12'- 6' - FIRE PR�OF SHAFT OETAII r - , o � _ _ 1 1- �I I � r - i� r,� I I �� I I 24' � i � � �'1 � - �G/ _ J _ _ _ J PIJLL STATION . LOCATE� AT EGRESS � � � lg LISTEO � � 6AFFLE FILTERS 1 , / �/0, � � AN� LIGHT FI%Tl1RES I ______ IIWI Ilnn oaoa Illo a fi, fi, � ______ �y � � � 11L 300 FIRE z x� � Sl1PRESSIDN SYSTEM 0 q A�TOMAiIC GAS U � � ""ei SHlIT00WN VALVE 0 � FRONT ELEVATION SIDE ELEVATION o � � � �I � / . . . . � Sal�m City Ha xisi � � , Existing �xhaust Hood �xaust I-�lood Above, up To Roof. Secure Existin St refr t Cslass Door In��oaed Po I � I I � ain�ess 5teel And Infdl Sehmd With Partiti �_ v ° �,,,,. � �. cou.r�er :: - 1- Landmg � � �fo Wall, O ac{ Cs�azing Pane) Oven I . „ i; � �'� 6- Burngr _ � n � wood Panel Paint. . . T��e � �rdi Csas Ra e Ran e I 1� � � .:. ... L— — : , � . .-.. . . .... �: : : : : : : , � — —————————————I . . . � . chen '� SS. � � `: table Exhaust Nood �FD Above sh ar s y�pica� .411 42° I�alf Wall and S�nks, Sot Sides. � � Refrid erated +� gnag - 'Bu�k oor To Rema�n o ood � �� E Uno structe At I� Times' �' H, . DN �.d� Beverages Count Reach-In Ref. Ewstin ` #87 Bu ea Outside Seating C22 Seats) Remove Meta) ing Infi��� Wel) Opening O O � And Level Platform �or HC� P Egre� _—___- � Ice � New Men'e i: � ray Pavers ( r � `) �a P � o � �:� `� � � �:� o -� Cs�ass Shelve � ' � � `n SofP�t Abov� taineas Stee Gount 0 �� _�an.�_ �1 Ste�n i. . ��// ��i .�/�G� ��-�o� . , Y� f ^\ Thc C'umnwmcr:illh ui'�9assachuseus �� , �� ;; B���rd �it Bwlding Rcgul:uiuns :uid Si:inJ:irJs P�il: ��/ \II'VIl I,P \I.I I1 : �/ V� / {Y,�f� i�iassathusctts SWtt l3uilding (�ude.7SU('MR. 7"' ��itiun l'.tili ' nJ � � .,, I3uilding Pcrinit Application To Construct. Rrpair. R�no�at� Or I)cmi�li.tih a R.����J l�m���,�� One-ur Piru-Fui�rih� Dirrllin,q L -����,�' f —� This ' •iiun Fur Oftirial Use Only Huildine Ptrmii Numh . Da1e Applied: _ ---- --- —� $I_�1171UI'0: Y//O '__"__'__ I � _���.___.-_ _ . � � l3uilding Cummissi�intr/ In�pcciur ol i iil ii �� Uaic � �� ', -----� tiEC7 N L• SITF. INFOR\L�'f10N —_---- 1.1 rop�r[y .} , �ddress:_�n ^��� 1.2 :lssetisurs M1lup & Parccl Vuwbcrs -- �� � � (YIQ� �� (J1 � I.I:i la �his an arrepted sirrel? yts_ no M1lap Numhrr i i : ;� P:urrl Numbrr �I 1.3 Zoning Informutiun: L4 Property Dimrnsiuns: Zoning Disuicl Priipused lisr Lut Area Isy li) Fronui@c ilil � . LS Building Setbacks(ft) � � Frunl Yard � SWr Yards � . � Re�r Yard ! RryuircJ Provided : -Reyuired PruviJed RryuirrJ Pru�i���d . 1.6 Water Supply: IM.G.L c 10.§Sd) 1.7 Flood Zone Informatiun: 1.8 Sewuge Disposrl Systrm: Zune: Outside Flood Zone'? � �.hmici al�❑ On site dis�usal s ,icm ❑ Public❑ Private O Check iF yes❑ �' I >�. SECTION 2: PROPERTY OWNERSHIP' �/O�nler�qf_Rec�dre�n('an n '___�r_r �A � i I I mrr P (�� NameiPriml V , AJdress (orService: � � �a��3�6U - . � � Sienamre � - Tclephune SECTION 3: DESCRIPTION OF PROPOSED WORK�(check all thaP applyl New Cunstructiun❑ Existine Building ❑ Owner-Oceupied ❑ Repuirs(s) ❑ Alteration(s) ❑ :\ddiii��n ❑ Demolitiun ❑ Accessury Bldg. ❑ Number uf Units_ Other ❑ Specily: - Briet�nS�.�f�rup���l �Cf'Dp � � �Jld 1 �• rA 1 � � �� SECTION 4: ESTIM.4TED CONSTRUCTION COSTS Esiimated Cos�s: p���al Use Oniy I I�em (Lahur;md Materials) I. E3uilding `S G� � duildin� Permit Fee: 3 InJira�e huw lee is drtcrnunrd: ❑ S�andard City/Tuwn :lpplicatiun Fee ?. Electriral � O Tutal Project Cost' (Itzm 6) x multiplier x ' i 1. Plumbing 5 �. Other Fets: $ � �. Mechaniral iHV:1C) 5 List: — — j 5. Mechuniral IFire � -- , Su� re.�i��n) I 'f�rtal :\II Fees: $ Check �u. Chtck :\muunt: ('u.h :\m��unt:--_- i �. fotal Project Cost: 'b '�j5� � O P�id m Full ❑ Outncuidin�� 13ul:mre Uue'_=--- '' , v s�c�rioN �: corvsrRuc'rioN sF:RvicFs � 5.1 I.icensed Construction Superrisor ICSI.) �,-7—���_ ���/_I �f/� r I � _..J1_.L <�r_�c� �nhv� Z Lir�n.c \wubeY li.�pir.wun U.ua �ameofC 'L- ILII t� " � . N Lu�CSL'1\pc Isce hclu�cl __ � } � 1\� c - Dtscn�uon . \�dre�,s�p I � �G�7 C t'nrcslncird i u i lu?j.U00 Cu. fi.i � R � RcsiriricJ I.@_' Fanui� D��.•Ilin_ �� � �� �r� ' � / . �1 \I:nonn Univ . ��I RC RrsiJrnual Houlinc('o�crm„ Tricphnnt �\'S Re.id:nual \��indu�� .�nJ SiJin_ _ . Sf Rr>iJimi:d tiohd P�.irl Burnin,� \�ilrmrr hni.ill.wuu � D Re.�denual Ucmulmun i����It�dn rnvll ppo�mepn yotr•rrtor I I IIC) l L� I �n��Gj -- � C I ( �--- NIC Cump:m Vann ur IIC R����lr�Nanr Rtgistrutiun Vumhrr AdJress I 10�� I O"�� ��� '� . � Fx ratiun ite I Sienalure Telephone . SECTION 6: WORKEHS' COMPENSATION INSURANCE AFFIDAVIT(M.C.L.c. I52. § 25C(61) Workers Compensatiun Insurance aftiduvit must be cumpleted and submined with this applic�tiun. F:ulurc tu pru��id� this uftid�vit will result in ihe denial uf the Issuance u(the builJing permit. Signed Aftidavit Attached? Yes .......... ❑ No ........... ❑ . SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Q � �� p �^ 1, �Tucl �� I"—)���A��.�n I Wv1 , as Owner of the subject property hercby � authorize �—�'1�—��I �—�IUIl--Y-1,Q �f �e� r Z.� /� � tu act un my beh:tlf. in:dl matters relative to wurk:wthorized by tfiis buildin�permit applicuti . � � � i . , , Si nawre ol Owner ���� � SECTION 76: OWNER� OR AUTHORIZED AGENT ECLARATfON �. �'h r � s� �h o r zJJI /V , us Owner ur.4uthorized Agent hercby de�lure tha[the statements and iniurmation un the foregoin;. pliration are true und aceurate, [o �he bzs[uf my knuwle�ge and behalE .. Print N� e � . � SignaWreufOwnerorAuthoriud.4gint Date � . � ISiened under iha ains and enalties o( er�u � . NOTES: I. An Owntr who obtains a buildin�permit to do his/her uwn ��urk, ur:m uwner who hires an ume�:iatercd rumracwr (nut registered in the Hume Impruvement Cuntractor(HICI Programl, �vill nnt ha�e access to the arbitraiiun program ur_=uaranty Fund unde�M.G.L. c. l�_'.4. Other impurCmt infurmatiun on the HIC Prugram and Cbnstruction Supervisur Lirensing(CSLI can be ti�und in 750 CMR Reeulati�ins I IO.RG and I IQRS, rt�pecticely. ; ' W'han,ubstan[iul work is planned, pruvidt the intiirmutiun below: - I Tutal fluurs area lSq. Ft.i rincludin�g�rage, tinished ha,emenU:ittic�, derks��r p��rrh� � � - I Gross livim� arca iSq. FtJ - H;ibitablt ruom r�tunt _ � I Number uf hrrpl:ices - - Number uf hedro�nn.� ___ ', Vumber�if h:uhru��ms � Nwnber��f halt7hath, ____._ � Pvpt nf he;itine s}'+�em Vumhtr nf Jzcks/p��rnc�, ---------. i 1}'pe��f cuulin�� sy�i�m � I:ncin,rd _Upen ._. � 3. 'Tuial Project Syuare Puu�age" m:ry he ,ubstituted fi,r"Iuud Prujeet Ca,t" I � � � ''� CITY UF SALEM � � PUBLIC PROPRERTY � �.�J'` �'?a`,�� DEPART�IENT �..�cir:<t i, i�Ki;� ��i i � ��•\T'�K 1��'.\��.1illiW�f��\SiHFFI � S\li�\I. ��.\��.V III �41 :�.�'� : . 11.i:�i'8-'�;•r,�; � F�z:'�-g.-�.•��d�o 11'nrkers' Compens•rtion (nsurrnce :�ffidr�it: liuilders/Contractors/Electrici•rns/Plumbers 1pUlicant InR�rmation Plcase Print Le�iblY `�:itll� i[3u,inc,s�hgarii��uon InJi�iJual.0 Q �' � d �����lJ�-��J-✓�t� . - :i�i�t«S5;J1.5 Nr�r'-Fh Si� ��- City,State,Zip: �IPm H� a�q�b Phone �: � �I7S5 ) 7!-II - ��-IaZ�"I �re cuu •rn empluyer?Chrck the •rppropri•rte box: 'fy�pe uf project(reyuired): I.�I �in a employtr with�_ �. � I am�gtneral concratWr�nd 1 6, � �tw cunsiNctiun cmpluyees(full an�l%or part-timel.• �i��'z hired ehe sub-cuntrac�urs '.0 I �m a sule proprie[or ur partner- lis�ed un�he attached sheat. � �• ❑ RcmoJeling .hip and h•rve no empluyets fhese sub-con[ractors have 8. ❑ Demulition uurking tbr me in arty capaciry. µ'urkers' comp. insur�nce. q, � puilding addition . . �Vo wurkers' cump. insurance 5. ❑ We are a curpor•rtiun and its �0.0 Electrical repairs or additions rayuired.J oflicers have aeercised their 3.� I am a homeowncr doing vll work right uf exemption per MGL t I.❑ Plumbing repairs or addiAons myself.[No wurkecs' comp. c. 152,$1(4),and we h•rve no ��.� Rouf re`pnaifrs insurance reyuired.] t zmployeas. [No workers' I}',�Other V U �Q����� comp. insurance required.� •Any applicam Ihal chccks bux ql must also lill out the sec[ion below s'Iwwing[heir workm'compensatiun poliey informutioa � - . �I lumcownrn who submit thie afTJavit inJicating they are doing�JI wurlc und ihan hirc uutside contrutors mus�aubmit a new affJavit indiating such. �Cumracinrs ihat check thia hnx mucLattached an udditiumi sheet shuwing the name of�he sub-roNractors:uid Iheir wurkers'comp,pulicy informntion. , /am un rw+p/nyrr�Gur rs praviding rvorkers'eo�nperesution insurunce jor my empinyees. Beluw is�he pulie•y und jo6 site rnjar�nutiun. 1 / Insurance Compuny Name: �ti`� T1�Qv�� Pulicy#or Self-ins. Lic.!i: � �� M�� (,(� Expiration Date:��� !ub Sitt AdJress: 1 � �� I I I ! I�r C IC U.O� Ciry/State/Zip: �� 1 N Attach a copy of the workers' compensatiun policy dedar•rtion page (showing the policy number and expiration date). F�ilurc m srcure co�erage as reyuimd under Section ?SA of�iGL c. I S?can Iead to the imposition of criminal penalties of a tine up tn S I,�110.I1Q anJJur une-year imprisunment, as well ;is civil penalties in the torm of a STOP VVORK ORDER and a fine �rFup ro 5?j0.OI)a Jay agains[ [he viulatuc [3t aJvised that a copy uFehis srrtement may be f'onvardeJ to the Office oF In�rs�i_aiiuns uf'iht UTA fur insurance cu�erage cerifira�iun. l du herrhy eri'rif'}•un •i dtr puins�u J pri�u(ri . uJ'perjtrq�rlm�d�e injnrn�urinn provideJ nbo��r�is vue uuJ rarrect . � \I 7 Ullfd'� �� ��81tl' rJ7 `�✓ <<, ,, - � K- � UI - ��-I2�1 U(Jiriul i�sr unfy. Do nur u�ritr in ihix ureu, tu br crnuplr�rd hy�rit}•or anrn oJJiciuL ('itc nr fo��n: . —.---------------- PcrmitiLiccnse q_.__..----.---- lticuin4 .luihurih (circic une): I. lioard nf Hc�ith 2. 13uildin� Ucpurtmcnt 3. Cit�ifann Clrrk J. Elcctricrl Inspcctor 5. Plum6ing fnspector 6.Olhcr Information and Instructions � � \I.i>..�.'Inucus(�rncral La�vx�haptcr I�_ rrqwre::ill emplu�ar; m pru�iJr uurkcrx' cnmprn;:uion ti�r ihrir cmplopees. I'�.u;u.uu to�his,tamm..m rnrplqrer is,le�incd.i,"_ c�en prr.on in�hc sen i.e u(enuther widcr�np cuntra�t uf'hire. ,•��,rc.s or impli�d.nral ur��rittcn." \n .•mpinrrr i;del intJ as"an iuJi�;.lual.���nnrnhip..i::uciaiiun,enrpuraiinn ur nihcr I��al rntin•. �ir anp h�u ur murc ��(ilic ii�rr�uing rngagrd in a juint cntrrprisr.and including thr Ir�al reprr.cnt�ti«s uf a Jrrtaxd employcr.or ihe r.cci�cr ur vu.ict u�.�n indiciJual.parmrr>Ill�.d1iJl Id4Jf1 J�ulllCf IC_�7I tI1111Y.Cf11PIJ\Illa CfitPIU)"C25. I IUKYII'f lI1C ���,�ner of�d��clling huus¢ ha�mg nut murc iha�i thrce;iparnncnts anJ uho resiJc,thercin, or ihe octupanruf tht �h�rlline hau,e of':inuther a ho rmpluys prrs.in;ro do mnintcn�nre.:un:iruction or rep�ir��ork an sueh dwtlling huuse �n•��n iht_ruun�U or huilding:ippurtenant durrio,hall not ht.ru;t�itsuch cmplu�ment hz Jrr�urJ eo be �n rmplu}er." �Ic�L�h;iptcr l�2, �?SC16�alw;iatrs that"c�cry stute or locrl liccnsing�gency sh�ll withhuld thr issuance ur rcne�vvl uf•r licrnse ur prrmit to operate a business ur to construct buildings in �he cummonwe•rith for uny applir•rnt�cha has not pruduced acceptable r�idence of compliance oith �he insurance cuvrr�ge reyuired." ' .\dditiunally,�IGL eh:ipier 15?, §�j��7};tarcs"Vcither ihe eummumvralth nur�ny ufits pulitiral subJivisiuns shall rm�r intu any contrac[f'ur tht perfomiance utpublic+�ork until acerpiablt e�idencr uf rumpli�nee with ihe insurance rc��uirnnents uf this ch�pter hacn been prrsenteJ w tha cuntracting�uthoriry." �pplic•rnts Pla�se lill nut the workers' comptnsation al'fidavit cumplttely,by checking tht boxes that apply to your situation am1, if n�ressary,supply sub-cuntractor(s)mm�e(s�,aJdress(es)anJ phone number(s)alung with their ceniticate(s)uf insurance. Limited Liabiliry Companies(LLC)ur Limited Li•rbility Partnerships(LLP)with no employees uther than the mambers or partners,are nut required to carry workers'rumpensation insurance. If an LLC or LLP does have employrzs,a policy is requiced. Be�dvised that this affidavit may be su6mitted to the Department of (ndustrial :lccidents for confirmation of insurance coverage. .4lso be sure to siga and date the affidnvit The afti�favit should be rctumeJ to the ciry or rown that[ht�pplication for che permit ur license is being requested,not the Department oF Industrial Accidents. Should you have any yuestions regarding the law or if you are reguired to ubtain a workers' cumpensation policy,please call the Deparnnent at the number listed below. Self-insured companies should enrer their seff-insurance license number on the appropriate lina City or Town O�cials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of�he affiJavit for yuu ro till out in the ecent the Of'fice of Investigatiuns has to contact you regurding the applicant. Please be sure co fill.in the permiUlicense number which will be used as a reference number. In addition,an applicant that must submit multiple pertniVlicense applications in any given year,need only submit one a(fidavitindicating current policy infortnation(if necessary)and under"la6 Site Address"the applicant should wrire"�II locations in (ciry or tuwn)." A cupy of the allidavit chat has been uFficially stamped or marked by the city or�own may be proviJed to�he :ipplicant as prouf that a valid at7idavit is on tile for fiimre pertnits or licenses. A new af'fi8avit must be tilled out each yrar. Where a hoine owner ur citizen is ubtaining a lieense ur pennit not rtlatrd ro any business ur commercial centure (i.r. a dug license ur pertnit to burn lea�rs rtc.)saiJ persun is NOT rcquircd to complere this af'fidavit. The�)tf ice uf firvestigations �coulJ IiAe tu thank yuu in�dvance for your euoperation and shoulJ you hase any yuestions, plcasc Jo nui htsitatc to give us a call. I'he Departmrnt',aJdnss, telephune�nd tax nwnbcr: The Commonwealth of htassachusetts � Departrnent of IndusMal Accidents Oftice of[nvesdgatlons 600 Washington Screet I Boston, MA 021 ( 1 TeL N 617-727-4900 ext 406 or 1-877-MASSAFE it��.�:�d :-'c>•u; Fax # 617-727-7749 www.mass.gov/dia �[�PQSAl. E�F QE�E�FS �F�[�t���'�' � _ __. _ : Bn accordance v�ith the provisions of M. G. L c.40, Sec. 54, a con��ion of ! Building Pertnit Number is that the debris �esul6ng srom�his�ror�shall be disposed of in a properly Gcarssed faci6fy as defined.by 6�1. G. L c. 111, Sec." 150a. I � � • � The debris v�ill be dispesed �t Sa6e�s '�c�css�r S�a�a� o�ed �v �6orE�ss6de Ca�e�a � - . __-���� � � , �Sigrsatvre of Perrssit pGc�nt � � ' E?ate Chris�oph�r Zorzv M16ame of Pertnit Apptic�nt A &A Ser�6ces 8�c. Firm hame '!�'51�4orEE� S4r�et S�k�s� �e�s �'i�r`0 . Aadress, Crh'� S�te, Zi� Caae • , • F +� �I:tssarhusctts- Dep:u-tmcn[ af Public �:tf'et� I � . . � . � j � Sa:ird of'Suildim� Rc�_ulation,and Jc:milards . . . Construction Supervisor License � ' ' � License: CS 57733 �� � ' � � � Restricted to: 00 � ' � ' CHRISTOPHER ZORZY I 1'IS NORTH ST SALEM, MA 01970 ��=;, . � � �'-o-L !3'!xj� Expiration: 526/2011 . ' � (�ommissiuner Trti: 14757 - , . . I . � _' . ' ., --, - .._.� l ' , . � . � � , � . , . , _.--�.. .. _'._... ✓�-P �,' y-o' � �° . .. . . , .. . �• � ' —'""'� .. . __ .- �__ :� � ..'" �� . BoardoiBuildf�gR�evulatiauand�S�d�+5 . ... .,. , .... . . . . . _-._. �.. � . .--. . . . . .'--.. .. ..._ .. . ._ . . . _. . . . _ .. .. ' ` -�— HOME IMPROVEYIEM CONTRAC'[OR - . � RegistrdUon: 101609 E;Piration: 5/Zfi/2010 Tr� 257870 -<_Type;.Private Corporatian AEA SERVICES,iN�=;:��__,;; __�._—_: ChristoPher ZortlKl=_=y-r . � a . � 115NorthSireet ``:�.�e�','Y , ��,�,;� . � , . - . Salem,MA 01970 " Admicistrator . . • . . , , . .. . + � . � , . . . � . . . . .� _ . . • Commonweelth of Massachusetts � - Division of Occupational Safety � ' � , � � . � � � laura M.M�n,Commissior�r m� Deleader-Contrector �� � �,\y\y • CHRISTOPHER ZORZY �� � . . � � . � . Eff.Date 04/01/09 r,. -,.� i . . � . Exp. Date 04l08N 0 .; x , � � � � �DC000440 " � . � � Memberof C.O.N.ES.T.� . .4.F F i . �. � . . � BO - . -rk. ;� ' . . � . � " ' . III II�IIIII�iI�I I III' I��II �� III BOSfON-RENEW4 - . . . ' . . . . ' 1 . 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Attic KWaII.R13 Cell w/Membrane��;��„ r,�;� '„� ;��g��,33. �'„a,•�„',���„"�� � � �*� � Attic KneewallFloor R30 r'est� �` �, ,�;;*k � �;;�$T 14,. ,:a �;� � , : , � ,� . ,. KneewaA Floor'R30��::,�'�� "� ' � ;� — ���r �� ����g��"r " �Z' `�� '�- ' ; �� � �� � -�$1 14 � � �� '� �� � f=� ��' ' Sidewalis ��ui�l R�3 DP�`� � � �,��,a' � �;$1 39 � ���`t��,�a�� � � � „.�� x�„�a ; I`nte"'norWaAR1�3 PlastuR+13`DP ���,�° � � ��� 40 ""' ''�' � � � � � � � y�=I��"�s`,.'� s s�F Y#�d g�"-" # 7'est Drill Si�walls 4 sid�� %�"� k���„�.���, ;� y, ,� -- „� , „ , $53 OQ s�,�,e3z ta��`��, ��t ��'a �''�1 Duct Insula6on R9&Seal Seams s, '�������n;� ;�' � .:.$2 22 '^ .z;-�*...� ts�;,�s �,r,„4��€ ; H�dfO01C PI 0�PSU��0� f2S,�,^�i m ��'�. w,,^�°°E d �-,. � ' a x.,'��$2$9 si 't.'�a fi ae � � „ry :� . -�.�u s ,a ^� � �a --,� + :€ n.� � �_ SC22m PI e IItSWI t0 1 25 ;R5'� s *��+ '+'x"�;�-- �`}.{'�r 'ua% �;^+�°$4 68.�_• <: �s_+& �, �•' '2 � y � � >9s r DIiW Pi e Insuation R5� ;x+; F 'f�-r"�� :�-�'� s� � ��$2 05 � '�� � crr��,.s�; s yr �„ ��a��_ If1SUl2t8 DOOfs.A r + �� ,;3 � "z- �' r ,�� $36 50 p 3 ��'a.F : -„�. a . ^; .rvr�+�iS9 �Y'� Y .iqS�? c't.�z3Tm+.ve'°..�"'3��3i�d:�'�r.i"'��`�.�4� � E *a^G b,3. F-5+a "Iet a= ^u ,}�'S si� a� a'' WQ 0� ,R, 1. 6. �S. 3=resu vr r .. s _. - �'l .�'.��� p „ Insulation Totals � , a:*. ' �,� �� � E ��=,�� +, � _ ; ' �;:$0 00 = = h $0:00 S ,,. .. .. . � . [ r A : �` ' M `L 'Y�."*si {- �'� 'a� . . ,. . . -_.__ _._,___� �__"`^�i—+ _ �..::'3.:� ti�u"_..._.....�ee �^" �.€� tt �, F� x z<n. ` ^a`�^�.-_ y +z r.r �s __ __.m�xi:a S. ��'.a.._u a�".�a...__e•6`"� -' . ��� - .,yr�y � .:.Ea t . ; � ' � „ . . . ._ Judith Branconmer�, , "4 ;_'PBge 2 „ .c ,;`DOE, _ 3•* , 0 e , ^ "' I �3.:, L+`. . :3 �.2 c Othier'Measures.� .:�;. ,r•�„ ; , Est, ; , . ;Act .., . '�x Cost�w .� ,�Est �pst . . .m�Act Cost aa �� Roof Ven2 '�small , �:;-. „�, ,.,. �;' �� ::s.$66 00' s �.;c,�--,,- � . :� ,': __ .. Gat,1e Ve"nE � �: �._ ,. .: . .F'. _:�'•$76.00 r �... .. . a ; y � _E4 a � � Vm I Re lacement Window 73 ui ;" '� �- 16 ';^=., T `== ��- - ���� ' � �$312 D0 �`_ .;$4 892.D0'� � � � � � vin I Re lacement Window .83 ui .• --�� t`�,,-., :-=�Y,:� F;+ �s ;;$327 00. � ;'��,x,t���; ,�w „ „�; �� � + I � Vin I,Replacement Wmd'o'w 93 w �,"< ti � ° _;;�; ;E' . * �:� e�, x°y �, � �. z�.-� � = .�$33800 - � „ � s , , Vin I Re lacement Window 101 w-�'_ �„,,,- � ' „ •� "� �-$353 00 f:� �+,..� �w,�-aa '� � :� a�r � � Vin I Re I Bsmt Ho er-Window . �� ;'' ��x,e;s�f r+� . . .. ' � �,. 7` '� .",�$200 00 i `�e �ti�',� '� �'z� fl""��ta. Steel Pre Hun Door wlLite ' 'x ��<�,:,�'""'" ��. � „'� „$490 00 � '"a � t�� �� "� � . SolidCoreDoorwfHardware"` ��x�.y��� � �,�$33000 ��: �,c�,+rs!„e,�� .� �,�,,,r;,�� :�,�,,� FaucetAeratorrs�.,:n � a x��`� � 3 �'��`°-,��;= .� �:$150�",,� �,�$4500"�' � "�.snt��sc�4�s Low Flow Showerhead='�`'-`�.�af� �' ��` ��; .r �� �g �. � °�� a� _ � . 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Energ Conservation,', ��_ „ L ��,�,,,.„�-,--,�?� � =;�r���,-�,�� :;i����s;,� �; rU_Est.Cost�a'.# �ActCost,�si TOtfl15 �(M3)C$10 OOO,OO}�_.�r.a�. �o^ ':�� ,� a�"a;5?'s" ;+T *`z =, � ,� -.: `^�' Y"'� :..,- a � � ��r� � " $5 037 00� � ss�..$0 00 °�' �:Ta«'F i-��.0„�r�i 2^4�'�',��rw^;yfi `�'•�`'.�n"TW+':ia3 s���*",�.'t.�.b��i3 ss�,,."� '"�f�`„%.��.' jafk'r ��'�,=9� ��� '�a 3 i� �:� ,. .r, �;g `n�'n ... _.. Repairs�'�'.,��st„����,;�'� g gk�;Est•"�;;;d,�, � ���Act �� ' `�,Cost� :�", a�Est,CoSt�' � .�AetCost's= F.te a�dRefit;Door '.;�,j.,� �'"it�",�,'�..,�i"';°� - �., �,. r:� . � �$37 75 e`t: :,'� i��st��.� � : s"E,r� +,; Ad ust Door Stnker Plate:?`���� < <�. �,r��„� � �, i° 20 00 �' �`��-t` x +at£.:_Nry�'� ,�'�-^!�``�'�.ns;s �$ xTM+.;'pss��` i aaa��`Sa' ���iA.�$°�eiauyi . 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Fiealth &�Szfe ��' �`�"� s-� r� � & s� ;�"` � .^e 4�^z .� -�?s ���n,i� xr� �•yr�`�,s'ty "-� �`.-.��'�x .�t � �'s'�.,T'^��M �"��`���-�lw'-i�1 . r+a'�5,.,3zc -: s%s cr+�k Vent;Clotfie'siD erto E#enor� a' �;; '�s� �` �:�$70.00 �� �'�,,„��?�F��� � s��z��'„�3Y�; Vent Bath Fxhaust F"an to�Extenor:` ���� ,m �,'�$70.00 <+�'3�,���:�a„s'r� � $����'_�s�'��;� Re lace D"e�Hose"� ' ��, ,*, .: r � -a .. .- �s=� `�a'i,$.32�0�'3ti s.,w 5�i€a�,',@.e';,4�"s�,k %a �.„,€'��@;SrY�a`i s' �+. � .��S�i�"�� � �z. �?!'��z..-x.�{a:......'�:�' ��.�- ,$�.Q�. �+����ii'§_n��° . �"��.��i.:�k�9,��,a§�c.: �` ��'.°� �-`�;���� � =�.�:s. �_ �:� �t'� :=,�n$a.00��'����,x�; :s r��,��,� �..; : sn � �. � .�.� .��5'�g-�,.s.�"sa�`�k ^u�.�sc�:� ��� �$��� 'G '� i x4�t�3xi.i � $- ��'+��P�$i� �.:; Re airTof Max$2500`00 � �a �:a.'����� �� � ° �`�; �t ' f,, �.�: �;r ��� i$000�`�-'� � ;��:�$000 �,;�� �Es'c�k'�x2�y ar �,� as a� *+e-t ,ksa -ewi— �� �.sa -.! d+^ i � � �ay�'�,`�sm�`x 'Y� ��i< r �� rr���;Pv����z���c",��;°`��p„����w ''�� �"��'��- "� :¢- n ��� � �$.`'����.:.,-�'�".#°°��`w'� +�.z��,„"�-,��� es�`�g- �.�'sv-aa x��`�..�_,:;�'s�"" , �.`�"�"�''a� ' �� �-Work,Order Sub;Total .� ��:+�.� a�.�,�_.. < ._�� �r'�-���""_�. ,< ..����"� v� '�$5,037.0.0 �,� ;;.�:$0 00,�a.:;, a ; ��,"�,a�ry�""�,��ar�c� �"'��'� �s�-�r�`a r.� �v�Ss"�'e�" �: ,���g`,�$� .;� �i' "" a�� �:z "° , iw w w' �. t =�` ^:m€ z��'� r F ^{ssl�y 4�4-.r a�`r�`��^-:F,3=a° �. �` ' �>�a .5� .-3 '��' ".�"w� �'��,a�is�'���� t.� �.��,�'ss.",�'ik�r""�,3�+�F'�"�a�s�.^`�`3�# x?�-��� ��a�i �3T��w�� . u�,�u �s �'" s i -"c. ��'i`�. 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"'��,..�.v.y ^�r s' @ }� t.k -� g� �.y -. i (2 1 C5 r�� m �",�V�Q�� FY 'Y'1�'"''C�+i{{ft � � 9�i:.k'lxft. �S�3' t � -�+� x^�Z�cw Otfiei -�s� �' "�,:a.�'��" s'a �i .3',,� x qm:s�e.�� � - . � -� r � � . .��,'$�D�s�' �$., e5 3�v't�a.- ..s '���ae�'�t �%�'sE'��' i �=r.�'*Heatm S stemRe aira`"aF '"`�".;���`����`�' � .. �''$000, ��' ;��� �a��;'� ;,�" �� Action a roval oN � �; ',°` ��'�a� "°'� '_� �:��r a � � � a � � ct$0a�OO-t �' i ,��� PP ��� �Y ����'�c���ars�'��,^7°-�"����"'�'��,�r�`w=-"y,;�"`��.a ��.�;,'��'%�y€^����'�"�;"�'���i�g��*"a-�s�'�;''� . a L^,a�"« .�,�'x.."'&^x c. =�: °� '� 3?��'-.x��;''s'�& �;:� � '��,;�� �'.�,�-^ �.'�������`��.�'� , ,: � ,a �� $5 037 DO� �,;�� � , �? , a���k �,� � �� r�� � ., �� � EstimatedJob Total � �Job cannot exceed$10 000 00�x rr'"` �- �7s"�"ire'�� :`" t'�s�.pe"•a'�$x � �za�,� �t�y' aEt s� '"'"a x� +��"h t�t � "�, . c, � ���'a'xti.`��d �s f �.t�:aa� �^ q 8� ° "r r' ��`�*�° �'.: �"� x:'i�3�i�_. � Job mmimum $200 00 �,;, } � ,��` 9 . � Job Grand Totai .,�,°^�»�r��,,,>.' +" �$p 00 '� � � �"��ra�` ���� a P� �^ y r+�^�'#� ,4�,�:!'+.g? ¢i x �^' U �e�' r s. � a x .�� 4 a � y 1.�a s*.'r.. � " _ ,3�"a,3p°.� '� � �Q �. '�'�n^..y s ='�,'1 �k.'�r �� a�xesr � '.' � r �s 1r +. r"�'-�, , .�^"� ar- -n'�"�i. -'s.�Ic y�'�� xi�'=';y".+a ''�-'-'x�N-'�:;.'"`"?^ *,.'�" . ,c;�:�+ � ..rz� �,^g� �:;"„�,�.,��,,�"` ,AUDITOR ,�V1/oodySwan ,� , n � n�< � _,. � � � � _ �' v...::..._,�.:v;..�,....-2a,v�:�.a.�.a:�:zN.C..,<�'.,k�k�..W..�ka�....N"_u"��L�..��'"v;:�r�.�.i �"� �. .n . . •F .fi�J • � . . NQrth Shore Community Action Prograans, Inc. �T'eatlaerizatioaa ��,sdstcance Px�g��eoaa 98 Main Street, Peabody, MA 01960 (978) 531-0767 � October 21, 2009 A&A Services � . Client: Judith Branconnier 7A Fillmore Road Salem, MA 01970 �7� -7ys- 3S�y Notes: • This is a condo. Verify that owner has received permission for any work that will be visible from the outside. Insulating overhangs and sub roofs. • Walls aze insulated. It is unlikely condo association will approve blowing walls. ° Seal fireplace w/foam boazd. o We were unable to view the attic. You will need to cut a fuushed access in the hall closet. Based on other units we have inspected in the same complex the attic has R19 batt. • Unit has electric heat, add sufficient insulation to bring attic flat up to R48. Dense pack the attic slopes. Woody Swan I NSCAP __. � Project Coordinator �b7� . ` f��'(S 7'j�v�, 1,L p p�,��,,,.,,s �-F�.�,� ! 978-531-0767 ext 135 781-507-6119ce11 �L !'J %v')/GO G�vv� li,,�r✓ , '?� �- � [ l/ l G / �� J�z-�''r�' c-'�� , �� p� � r �/�ar_ w/ wc�u�v �/ / z -3 7aG� 6�,Wr =��y� ! T s !9�^� �mr�� �� �v � �-' p � P� Gt��w ,n� J� � I�� , 7b ;'N�s i�-� t� � ��r-A � = �//360, = \� l � �Lr¢Gi��(1 f�-�'(� �co G1J�%1/�U�Vj ��=�'2 /iVaeJ-d� /Z —3 - o %